Epcm l15 control of nosocomial (Hospital-Acquired) infection

EPIDEMIOLOGY & COMMUNITY MEDICINE
WRITTEN AND COMPILED BY DR. EMAN ABD ALHALIM MD, PHD
Third year
Level 6
Lecture 15
Control of
Nosocomial Infections

 Define nosocomial infection and infection control
 Discuss causes of nosocomial infections
 Understand the Infection Control Committee functions
 Explain instructions to decrease the incidence of nosocomial
infections and antimicrobial resistance (AMR)

 Infection Control (IC): The process by which health
care facilities develop and implement specific policies
and procedures to prevent the spread of infections
among health care staff and patients
 Nosocomial Infection: An infection contracted by a
patient or staff member while in a hospital or health
care facility (and not present or incubating on
admission)

 Disinfection: The process of microbial inactivation that
eliminates virtually all recognized pathogenic
microorganisms, but not necessarily all microbial forms (e.g.,
spores)
 Sterilization: The use of physical or chemical procedures to
destroy all microbial life, including large numbers of highly
resistant bacterial endospores.
Procedures include:
 Steam sterilization
 Heat sterilization
 Chemical sterilization

 Hospital acquired infections are a common problem: prevalence
about 9%
 Hospital acquired infections contribute to antimicrobial
resistance (AMR)
 Overuse of antimicrobials (development)
 Poor infection control practices (spread)
 Hospital-acquired infections increase the cost of health care.
 Effective Infection Control programs are beneficial
 They decrease spread of nosocomial infections, morbidity,
mortality, and health care costs

 Poor or absent IC practices, especially in intensive care
units, results in cross-transmission of antibiotic-resistant
bacteria.
 Poor knowledge of health workers about sterilization,
disinfection.
 Increased antibiotic use (e.g., broad spectrum and
prolonged surgical prophylaxis to prevent infections).

 Most common sites for nosocomial infections
 Surgical incisions
 Urinary tract (i.e., catheter-related)
 Respiratory tract (airborne infection)
 Bloodstream (blood born infection)
 Common microorganisms
 Aerobic gram-positive cocci (Staphylococcus aureus
Methicillin-resistant Staphylococcus aureus [MRSA],
enterococci [vancomycin-resistant]),
 Aerobic gram-negative bacilli (Escherichia coli and Klebsiella
pneumoniae)
 Acquired, multidrug-resistant organisms (M. tuberculosis,
Salmonella, Shigella, cholera )

1. Lack of training in basic IC
2. Lack of an IC infrastructure and poor IC practices
(procedures)
3. Inadequate facilities and techniques for hand hygiene
4. Lack of isolation precautions and procedures

5. Use of advanced and complex treatments without adequate
training and supporting infrastructure, including:
 Invasive devices and procedures eg.; endoscopies
 Complex surgical procedures
 Interventional obstetric practices
 Intravenous catheters, fluids, and medications
 Urinary catheters
 Mechanical ventilators
6. Inadequate sterilization and disinfection practices and
inadequate cleaning of hospital

Membership:
 Doctors
 General physician
 Infectious disease specialist
 Surgeon
 Clinical microbiologist
 Infection control nurses
 Representatives from other relevant departments
 Laboratory
 Housekeeping
 Pharmacy and central supply
 Administration

Goal:
 To prevent the spread of infections within the health
care facility.
Functions:
1. Addressing food handling, laundry handling, cleaning
procedures, visitation policies, and direct patient care
practices
2. Obtaining and managing critical bacteriological data
and information, including surveillance data

Functions (cont.)
3. Developing and recommending policies and
procedures pertaining to infection control
4. Recognizing and investigating outbreaks of
infections in the hospital and community
5. Intervening directly to prevent infections
6. Educating and training health care workers,
patients, and nonmedical care persons

 Whenever possible, avoid crowding wards.
 Implement specific policies and procedures for patients
with communicable diseases:
 Private rooms and wards for patients with specific
diseases
 Visitation policies
 Hand washing and use of gloves
 Gowns, when appropriate
 Masks, eye protection.
 Precautions with sharp instruments and needles

 Establish a regular schedule of hospital cleaning with
appropriate disinfectants in, for example, wards,
operating theaters, and laundry
 Dispose of medical waste safely
a. Needles and syringes should be incinerated
b. Other infected waste can be incinerated or
autoclaved for landfill disposal
c. Bagging and isolate soiled linen from normal hospital
traffic

 Written policies and procedures are needed
 All objects to be disinfected or sterilized should first be
thoroughly cleaned
 Quality control in reprocessing is essential
 Monitor and record sterilization parameters (i.e., time,
temperature, pressure)
 Biological indicators should be used to ensure sterilization
 Chemical indicators are necessary for chemical sterilization
 Sterilized items must be stored in enclosed clean areas
 Items or devices that are manufactured for single use should
not be reprocessed (e.g., disposable syringes and needles).

Biological indicatorsChemical indicators

1. Intravascular devices
 Use only when necessary.
 Silicon elastomer or polyurethane catheters have lower infection risk
than polyvinyl catheters
 Prepare and administer IV medicines and fluids in a sterile manner, in
a designated uncontaminated area, using specially trained staff.
2. Urinary catheters
 Avoid in-dwelling urinary catheters whenever possible.
 Use closed drainage systems.

3. Mechanical ventilation and respiratory equipment
 Use only when absolutely necessary.
 Use suction catheters only once.
 Ensure that all equipment has ethylene oxide sterilization or
high-level disinfection before use.
 Wean patient early from ventilators.
 Ensure proper handling of inhalation medications and
supplies.

 Implement comprehensive policies and procedures.
 Minimize preoperative stays in the hospital.
 If necessary to shave the planned operative site, use clippers
(not razors) and shave immediately before the procedure.
 Use antibiotic prophylaxis only when indicated and according to
established protocols.
 Provide sterile instruments in individually wrapped sterile
packages.
 Use an effective antiseptic, such as iodine, to prepare the
incision site.
 Include perioperative scrub with antiseptic scrub for hand and
forearm antisepsis for surgical teams.

 Treat work-related illnesses
 Provide vaccinations to decrease infections:
 Routine vaccinations (e.g., diphtheria, tetanus, polio, measles,
mumps, rubella, varicella, hepatitis A and B, BCG)
 Vaccinations during epidemics (e.g., meningitis, typhoid,
influenza)
 Train health workers in:
 Appropriate sterile techniques
 Infection control procedures
 Use of barrier precautions (e.g., gloves) for certain procedures

1. Gown first
2. Mask or respirator
3. Goggles or face shield
4. Gloves
How to safely remove PPE
1. Gloves
2. Face shield or goggles
3. Gown
4. Mask or respirator

 Contamination of food and water supply frequently
occurs in hospitals.
 Inadequate cooking may lead to overgrowth of
pathogenic bacteria.
 Food handlers may contract an infectious disease.
 Policies and procedures to prevent food and water
contamination are necessary.

Bibliography
World Health Organization, Prevention of hospital-acquired
infections, a practical guide, 2nd edition 2002.
http://www.who.int/emc

Epcm l15 control of nosocomial (Hospital-Acquired) infection

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Epcm l15 control of nosocomial (Hospital-Acquired) infection